DR ELLILE CANNNON: My GP is refusing to test my son for prostate cancer  – is this right?

My 50-year-old stepson twice requested a PSA test from his GP to screen for prostate cancer, but was rejected. Both his father and his paternal grandfather suffered from the disease. He has no symptoms, but neither did his dad when he had his first PSA test at age 50, which showed elevated levels, and even when he eventually required treatment he did not suffer any symptoms. What do you think my stepson should do?

High levels of prostate-specific antigen, or PSA, in the blood are a sign that something is wrong with the prostate. It can be caused by cancer, but it can also increase due to a variety of benign conditions, such as infections or even after sex. In fact, most men with an elevated PSA level will not have cancer.

For this reason, the PSA test is not used as a routine screening tool, unlike mammograms or cervical smear tests that are typically offered to large numbers of healthy, asymptomatic women to detect breast and neck cancer. uterine in early stage. If this were the case, many men would end up undergoing unnecessary, invasive procedures to rule out cancer.

However, men over 50 can request a PSA test from their GP for any reason, as long as they understand the possible results, including the risks of false positives and other drawbacks. Before undergoing the test, patients should speak to their GP to weigh the pros and cons and can then opt for the test if they wish to proceed.

This approach is particularly relevant for people with a strong family history of prostate problems. It is surprising that the GP does not know this: the recommendations are detailed in the Government’s Prostate Cancer Risk Management Program published in 2016.

Prostate Cancer UK (prostatecanceruk.org) and NHS (nhs.uk) offer valuable resources to facilitate these discussions and provide men with comprehensive information.

Why is it so difficult to diagnose a vitamin B12 deficiency? I have all the signs and symptoms but my GP says my blood tests are normal. I just don’t believe it and I’m getting worried. I’m considering purchasing B12 injections online so I can treat myself. What do you think?

Vitamin B12 deficiency causes a variety of symptoms, including tiredness, sore tongue, brain fog, palpitations, and headaches. There may also be nerve problems, such as tingling and numbness.

We see low levels in people who follow vegan diets (as B12 is mainly found in eggs, milk, meat and fish) and also in people with intestinal diseases who do not absorb nutrients properly. It is also the side effect of some medications, including those that treat diabetes, stomach acid, and gout.

But the blood tests offered by the NHS to detect low levels are very accurate. If they return to normal, then there is no indication of deficiency and no reason to treat it.

Low B12 levels may be seen in people following vegan diets

Then I would look to see what else could be causing these symptoms.

Other tests may look for problems such as iron deficiency anemia, folic acid deficiency, and thyroid problems, as they cause similar problems. Perimenopause and menopause can also be a factor in middle-aged women.

Anyone who questions the diagnosis made by a GP should go back and ask for a better explanation or seek a second opinion, either within the practice or elsewhere.

I do not recommend purchasing medications online and then self-treating; this can be dangerous. It is much better to follow medical advice.

At the end of last year I had surgery to remove cancer from my right lung. Since then, I’ve been out of breath. I also suffer from high blood pressure and have been told I have too much water in my blood. The doctor says I can’t do anything but take my medication.

I can’t even walk in my garden. Is there anything that can make me feel better again?

One would expect an operation on the lungs to cause difficulty breathing, but there may be other causes. My first thought would be heart problems, especially in someone with high blood pressure.

Also known as hypertension, this condition puts pressure on the heart, making it work harder.

In some people, this can lead to heart failure, where the heart does not pump as well as it should. This causes fluid to build up in the lungs, causing difficulty breathing.

Treatment to relieve stress on the heart involves reducing the amount of fluid in the body with diuretic medications such as bumetanide or furosemide. In addition to this, other medications would be prescribed to lower blood pressure, such as a beta blocker.

Anyone who still has difficulty breathing on these medications, even during mild exercise, may be referred to a cardiologist for specialist advice, as more medications may be available. There have been some promising results for treating some types of heart failure with a drug called dapagliflozin.

Regular, gentle exercise is important for someone with heart failure and your GP may suggest a supervised group program for this. People with heart failure are also recommended to weigh themselves regularly, as weight jumps may indicate fluid buildup.

Don’t let a glucose device scare you about diabetes

I am not alone among GPs who in recent months have come into contact with healthy patients who are convinced they have diabetes. The reason? They have joined the healthy trend of using a continuous blood glucose monitor, as shown in the photo above.

These are brilliant devices that help patients with type 1 diabetes manage their condition – they need to know when their blood sugar is high so they can administer medication.

However, trendy diet app Zoe, conceived by famed doctor Professor Tim Spector and fronted by Davina McCall, recommends using the monitors to give an “insight” into how your body responds to different foods.

This raises unnecessary concerns as patients think that normal increases in blood sugar after eating are a sign of a serious illness.

My advice is that if you don’t have a diabetes diagnosis and are thinking about putting one of these devices on your skin…don’t do it. If you (or someone you know) is not diabetic but has been alarmed by seeing a reading on one of these monitors, please write to me at the email address below.

When the boss paid me a visit

A few weeks ago I met Amanda Pritchard, chief executive of NHS England, at an event. I boldly suggested to him that if he wanted to see a GP practice doing well, he should come and spend an afternoon at my practice in north London.

And so he did on Monday. As in all areas of the NHS, there are things that are difficult: we are struggling with mountains of paperwork and the flood of online e-consultation forms, completed by patients for the most spurious of reasons but which still need to be assessed. .

We are getting there, but I know from experience as a patient that not all surgeries are going so well, with ridiculous wait times for appointments.

I’m glad Amanda has seen this first hand as perhaps she can do something to alleviate this pressure and allow GPs to spend more time seeing patients face to face.